Healthcare Provider Details

I. General information

NPI: 1548295041
Provider Name (Legal Business Name): FRANCINE E. JOHNS P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FRANCINE E. LUCIBELLO P.A.-C

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5783 WOOSTER PIKE
MEDINA OH
44256-8816
US

IV. Provider business mailing address

5783 WOOSTER PIKE
MEDINA OH
44256-8816
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-0569
  • Fax: 330-662-0258
Mailing address:
  • Phone: 330-725-0569
  • Fax: 330-662-0258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.001495RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: